MEDICARE: GO 2 TRANSPORT LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)		CA

General Provider Information

NPI Number	:	1174987606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GO 2 TRANSPORT LLC.

Provider Business Mailing Address
First Line	:	9874 CAPE VERDE DR
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-6328
Country	:	US
Telephone Number	:	916-561-9586
Fax Number	:

Provider Business Practice Location Address
First Line	:	9874 CAPE VERDE DR
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-6328
Country	:	US
Telephone Number	:	916-561-9586
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JAMES ONG
Credential	:
Telephone Number	:	916-561-9586

Provider Enumeration Date	:	04/11/2016
Last Update Date	:	04/11/2016

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